Evaluation of non-adherence to anti-retroviral therapy, the associated factors and infant outcomes among HIV-positive pregnant women: a prospective cohort study in Lesotho

  • Ngomba Kadima
  • Tejan Baldeh
  • Kyaw Thin
  • Lehana Thabane
  • Lawrence Mbuagbaw
Keywords: Adherence, transmission, antiretroviral therapy, prevention of mother-to-child transmission

Abstract

Introduction: Success in addressing prevention of mother-to-child transmission of HIV depends largely on good adherence to anti-retroviral therapy (ART) by pregnant women. Knowledge of the levels of ART adherence among pregnant women is essential to inform strategies to prevent or reduce HIV transmission rates, particularly in African settings.

Aim: the primary objective of this study was to measure adherence to antiretroviral therapy (ART) among pregnant women living with human immunodeficiency virus (HIV). The secondary objectives were to determine: i) the rate of new infections among children at Mabote Filter Clinic in Maseru, Lesotho whose mothers were enrolled in PMTCT, and ii) the factors associated with non-adherence to ART among pregnant women.

Methods: In this prospective cohort study, HIV-positive pregnant women receiving antiretroviral therapy (ART) for prevention of mother to child transmission (PMTCT) were followed up to delivery and their children were tested for HIV. We collected socio-demographic information, knowledge of PMTCT and adherence to ART (three-day recall and pill count) including reasons for non-adherence. We also used logistic regression to explore factors associated with non-adherence.

Results: One hundred and seven women were included. The mean (standard deviation) age of the participants was 28.2 (5.7) years. Most, 81.3% (87/107), were married, only 9.3% (10/107) had a postsecondary education. Two-thirds (63.6%: 68/107) of the participants started ART because of PMTCT. Only 78.5% (84/107) of the participants had adequate knowledge of the importance of PMTCT. The three-day self-reported non-adherence rate at the first visit was 7.5% (95% confidence interval (CI): 3.7, 13.1), but up to 43.4% (95% CI: 35.2, 51.9) using pill count. The most frequently reported  reasons for not adhering were: running out of pills (7.5%), nausea (5.6%) and to avoid side-effects (3.7%). Women who were employed (odds ratio (OR) 4.35; 95% CI: 1.38,14.29; p = 0.012) and at a higher gestational age (OR = 1.43; 95% CI: 1.11, 1.85; p = 0.006) were more likely to be nonadherent. Only 1 of the 77 exposed infants was found to be positive for HIV at 6 weeks after birth.

Conclusion: We found a higher nonadherence rate for participants with pill count compared to a three-day adherence self-report. However, mother to child HIV transmission was relatively low. Lack of employment and high gestational age were found to be predictive factors of non-adherence.

Keywords: Adherence, transmission, antiretroviral therapy, prevention of mother-to-child transmission

Author Biographies

Ngomba Kadima
Queen Mamahato Memorial Hospital, Maseru, Lesotho-CTN International Postdoctoral Fellow
Tejan Baldeh
Department of Health Research Methods, Evidence and Impact McMaster University, Hamilton, Canada
Kyaw Thin
Research Coordination Unit, Room Number 326, Ministry of Health of Lesotho, Maseru, Lesotho
Lehana Thabane
Department of Health Research Methods, Evidence and Impact McMaster University, Hamilton, Canada; Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
Lawrence Mbuagbaw
Department of Health Research Methods, Evidence and Impact McMaster University, Hamilton, Canada; Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
Published
2019-02-18
Section
Articles

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eISSN: 1937-8688